Safe and effective use of low-dose (450 mg/day) valganciclovir (VGC) for cytomegalovirus (CMV) prophylaxis in renal transplant recipients (RTRs) has been reported. However, it is unclear whether outcomes are consistent across African American (AA) and non-AA populations. The purpose of this study was to evaluate the incidence and characteristics of CMV among RTRs on low-dose VGC according to race. RTRs from 01/2006 – 10/2013 were included, all received initial immunosuppression with Thymoglobulin (ATG), tacrolimus, mycophenolate and prednisone. High-serologic risk (D+/R-) patients received at least 6 months of VGC and non-high-risk patients received 3 months. PCR screening was performed when clinically warranted, and routinely at 1,3,6 and 12 months post-transplant beginning in 2007. 639 RTRs (237 AA & 402 non-AA) were reviewed. The proportion of D+/R- AA and non-AA was similar (16% vs. 16%), as were age, gender, pre-transplant CMV IgG titers, cumulative ATG dosage, early (<6 months) acute rejections, and creatinine clearance through month 6. AAs had more deceased donor kidneys, greater body weights, and a higher rate of DGF. At 1 year, AAs had higher rates of viremia (24% vs. 13%; p<0.01), breakthrough viremia (8% vs. 4%;p=0.03), and ganciclovir-resistance (2.1% vs. 0.5%;p=0.06) compared to non-AAs. No difference in tissue invasive disease was seen. The difference in viremia was evident mostly in non-high-risk (20% vs. 9%; p<0.01) rather than high-risk (46% vs. 35%; p=0.26) subgroups of AA and non-AAs, respectively. In multivariate analysis, D+/R- serostatus, deceased donor transplant, and AA race were identified as independent risk factors for CMV. In conclusion, AAs experienced higher rates of CMV in the setting of low-dose VGC prophylaxis. The efficacy of this prophylaxis strategy warrants further investigation in the AA population.

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